Only half of patients receive follow-up care within seven days after leaving the ED with new diagnosis of irregular heartbeat

Follow-up care for patients over the age of 65 with atrial fibrillation (irregular heart beat) who present at the emergency department (ED) is associated with lower mortality. But according to a new study by researchers at the Institute for Clinical Evaluative Sciences, only half of patients who presented in an Ontario ED with a new diagnosis of atrial fibrillation saw a family doctor or a specialist within seven days of discharge.

Atrial fibrillation is a common cardiovascular disease, and its prevalence is projected to increase by 250 per cent by the year 2050. Approximately 15 to 20 per cent of strokes are due to atrial fibrillation, and those strokes have a 50 per cent mortality rate a year later. The prognosis of some diseases is substantially worse in the setting of atrial fibrillation and atrial fibrillation itself is associated with an independent increase in mortality among both sexes.

“Follow-up care is important for patients who are newly diagnosed with this arrhythmia, and most emergency physicians advise these patients to see someone within a week of leaving the ED. Not surprisingly, the most important factor in obtaining follow-up care was whether a patient had a family physician,” says Dr. Clare Atzema, lead author and scientist at ICES.

The retrospective cohort study examined all patients discharged from the 157 non-pediatric EDs in Ontario who received a new diagnosis of atrial fibrillation between April 1, 2007 and March 31, 2012 and found:

• Among 14,907 visits, half (50.1 per cent) had follow-up care within seven days of discharge.
• By 30 days, 18 per cent still had not obtained follow-up care.
• Among emergency and family physician factors, lack of a family physician had the largest independent association with acquiring follow-up care within seven days of discharge.
• Patients whose family physician was remunerated via primarily fee-for-service methods were more likely to be seen within seven days than those who were reimbursed via primarily capitation.

“Given that the number of patients with atrial fibrillation is expected to rise rapidly in the future, it is important for clinicians and policy makers to implement a means for these patients to obtain timely follow-up care after they leave the ED,” says Atzema.

The study was funded in part by a Canadian Institutes of Health Research (CIHR) grant. Dr. Atzema was supported by a New Investigator Award from the Heart and Stroke Foundation of Ontario.

“Incident atrial fibrillation in the emergency department in Ontario: a population-based retrospective cohort study of follow-up care,” was published today in the CMAJ Open.

Authors: Clare L Atzema, Bing Yu, Noah M Ivers, Paula M Rochon, Douglas S Lee, Michael J Schull, Peter C Austin.

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